Minimally invasive guides and cutting instruments

ABSTRACT

A surgical guide includes a first guide arm extending from a first end to a second end on a first longitudinal axis. The first guide arm defines a first plurality of openings sized and configured to receive a first guide element therethrough. A second guide arm extends from a first end to a second end on a second longitudinal axis. The second guide arm defines a second plurality of openings sized and configured to receive a second guide element therethrough. A pivot element couples the first end of the first guide arm to the first end of the second guide arm such that an angular distance between the first guide arm and the second guide arm can be adjusted in a first plane.

CROSS REFERENCE TO RELATED APPLICATION

This is a National Stage Application, filed under 35 U.S.C. 371, ofInternational Patent Application No. PCT/US2019/044587, filed on Aug. 1,2019, which claims priority to U.S. Provisional Patent Application No.62/774,385, filed Dec. 3, 2018, the entireties of which are incorporatedby reference herein.

FIELD OF THE INVENTION

This disclosure relates generally to surgical guides and methods of usefor minimally invasive surgery and, more specifically, to surgicalguides and methods of use for Charcot minimally invasive surgery.

BACKGROUND

Arthrodesis refers to surgical fixation of a joint, ultimately resultingin bone fusion. An arthrodesis procedure induces ankylosis performed torelieve pain or provide support in a diseased or injured joint.Tibiotalocalcaneal (“TTC”) or tibiocalcaneal (“TC”) arthrodesis is asalvage procedure for the treatment of joint disease or pain anddysfunction due to arthritic ankle and subtalar joints, e.g., Charcotdisease. In performing ankle and subtalar arthrodesis, the surgeon maywish to achieve anatomic alignment, pain relief, and a stable,plantigrade foot. Secure fixation while preserving the surrounding softtissue can also contribute to a successful outcome.

Anatomic alignment, pain relief, stabilization, or other desiredsurgical outcomes may require cutting or other bone removal to form acavity, wedge, or other space within or between bones for alignment andrepositioning of the bones. Accurate postioning and formation of cuts inthe bones is essential for ensuring proper relief and treatment ofCharcot disease or other arthrodesis. Current systems for forming cutspresent infection risks, slow tissue healing, and requires the use offrames and/or burrs that is time consuming and requires long incisionpaths.

SUMMARY

In some embodiments, a surgical guide is disclosed. The surgical guideincludes a first guide arm extending from a first end to a second end ona first longitudinal axis. The first guide arm defines a first pluralityof openings sized and configured to receive a first guide elementtherethrough. A second guide arm extends from a first end to a secondend on a second longitudinal axis. The second guide arm defines a secondplurality of openings sized and configured to receive a second guideelement therethrough. A pivot element couples the first end of the firstguide arm to the first end of the second guide arm such that an angulardistance between the first guide arm and the second guide arm can beadjusted in a first plane.

In various embodiments, a surgical method is disclosed. The surgicalmethod includes a step of positioning a surgical guide adjacent to abone. The surgical guide includes a first guide arm extendingsubstantially on a first longitudinal axis and defining a firstplurality of openings, a second guide arm extending substantially on asecond longitudinal axis and defining a second plurality of openings,and a pivot element coupling the first guide arm to the second guidearm. A first guide element is inserted through a selected one of thefirst plurality of openings defined by the first guide arm. The firstguide arm and the second guide arm are pivoted about the pivot elementto adjust an angular distance between the first guide arm and the secondguide arm. A second guide element is inserted through a selected one ofthe second plurality of openings defined by the second guide arm. Awedge osteotomy is formed in the bone. The first guide element and thesecond guide element are configured to position a cutting guide forforming the wedge osteotomy.

In various embodiments, a surgical guide is disclosed. The surgicalguide includes a first guide arm extending from a first end to a secondend on a first longitudinal axis. The first guide arm defines a firstplurality of openings sized and configured to receive a first guideelement therethrough. A second guide arm extends from a first end to asecond end on a second longitudinal axis. The second guide arm defines asecond plurality of openings sized and configured to receive a secondguide element therethrough. A first slide element is coupled to thefirst end of the first guide arm. A first extension element extends froma first end to a second end on a third longitudinal axis and defining afirst adjustment slot extending substantially on the third longitudinalaxis. The first slide element is positioned at least partially withinthe first slot and is slideable on the third longitudinal axis. A secondslide element coupled to the first end of the second guide arm. A secondextension element extends from a first end to a second end on a fourthlongitudinal axis and defines a second adjustment slot extendingsubstantially on the fourth longitudinal axis. The second slide elementis positioned at least partially within the second slot and is slideableon the fourth longitudinal axis. A pivot element couples the first endof the first extension element to the first end of the second extensionelement such that an angular distance between the first guide arm andthe second guide arm can be adjusted in a first plane.

BRIEF DESCRIPTION OF THE FIGURES

The features and advantages of the present invention will be more fullydisclosed in, or rendered obvious by the following detailed descriptionof the preferred embodiments, which are to be considered together withthe accompanying drawings wherein like numbers refer to like parts andfurther wherein:

FIG. 1 illustrates an isometric view an adjustable surgical guide, inaccordance with some embodiments

FIG. 2 illustrates a top view of the adjustable surgical guide of FIG.1, in accordance with some embodiments.

FIG. 3 illustrates a side view of the adjustable surgical guide of FIG.1, in accordance with some embodiments.

FIG. 4 illustrates a cross-sectional view of a pivot element of theadjustable surgical guide of FIG. 1 taken along line A-A, in accordancewith some embodiments.

FIG. 5 illustrates an isometric view of an adjustable surgical guideincluding a plurality of scallop guides, in accordance with someembodiments.

FIG. 6 illustrates a top view of the adjustable surgical guide of FIG.5, in accordance with some embodiments.

FIG. 7 illustrates a cross-sectional view of the adjustable surgicalguide of FIG. 5 taken along line A-A, in accordance with someembodiments.

FIG. 8 illustrates a cross-sectional view of a scallop guide of theadjustable surgical guide of FIG. 5 taken along line B-B, in accordancewith some embodiments.

FIG. 9 illustrates an isometric view of an adjustable surgical guideincluding guide arms defining adjustment slots, in accordance with someembodiments.

FIG. 10 illustrates a top view of the adjustable surgical guide of FIG.9, in accordance with some embodiments.

FIG. 11 illustrates a cross-sectional view of a guide arm of theadjustable surgical guide of FIG. 9 taken along line A-A, in accordancewith some embodiments.

FIG. 12 illustrates an adjustable surgical guide including multipleposition and angle adjustments, in accordance with some embodiments.

FIG. 13 illustrates a top view of the adjustable surgical guide of FIG.12, in accordance with some embodiments.

FIG. 14 illustrates a side view of the adjustable surgical guide of FIG.12, in accordance with some embodiments.

FIG. 15 illustrates a distal view of the adjustable surgical guide ofFIG. 12, in accordance with some embodiments.

FIG. 16 illustrates a cross-sectional view of the adjustable surgicalguide of FIG. 12 taken along line A-A, in accordance with someembodiments.

FIG. 17 is a flowchart illustrating a method of forming a cut in a boneusing an adjustable surgical guide, in accordance with some embodiments.

FIG. 18 is a flowchart illustrating a method of positioning anadjustable surgical guide, in accordance with some embodiments.

DETAILED DESCRIPTION

This description of the exemplary embodiments is intended to be read inconnection with the accompanying drawings, which are to be consideredpart of the entire written description. In the description, relativeterms such as “lower,” “upper,” “horizontal,” “vertical,”, “above,”“below,” “up,” “down,” “top,” “bottom,” “proximal,” “distal,”“superior,” “inferior,” “medial,” and “lateral” as well as derivativethereof (e.g., “horizontally,” “downwardly,” “upwardly,” etc.) should beconstrued to refer to the orientation as then described or as shown inthe drawing under discussion. These relative terms are for convenienceof description and do not require that the apparatus be constructed oroperated in a particular orientation. Terms concerning attachments,coupling and the like, such as “connected,” refer to a relationshipwherein structures are secured or attached to one another eitherdirectly or indirectly through intervening structures, as well as bothmovable or rigid attachments or relationships, unless expresslydescribed otherwise. Like elements have been given like numericaldesignations to facilitate an understanding of the present subjectmatter.

As used herein, the term “substantially” denotes elements having arecited relationship (e.g., parallel, perpendicular, aligned, etc.)within acceptable manufacturing tolerances. For example, as used herein,the term “substantially parallel” is used to denote elements that areparallel or that vary from a parallel arrangement within an acceptablemargin of error, such as +/−5°, although it will be recognized thatgreater and/or lesser deviations can exist based on manufacturingprocesses and/or other manufacturing requirements.

In various embodiments, a surgical guide is disclosed. The surgicalguide includes a first guide arm extending from a first end to a secondend along a first longitudinal axis. The first guide arm defines a firstplurality of openings sized and configured to receive a first guideelement therethrough. A second guide arm extends from a first end to asecond end along a second longitudinal axis. The second guide armdefines a second plurality of openings sized and configured to receive asecond guide element therethrough. A pivot element couples the first endof the first guide arm to the first end of the second guide arm suchthat an angle between the first guide arm and the second guide arm canbe adjusted in a first plane.

FIGS. 1-4 illustrate an adjustable surgical guide 100 a, in accordancewith some embodiments. The surgical guide 100 a includes a first guidearm 102 a and a second guide arm 102 b. Each of the guide arms 102 a,102 b includes a body 104 extending between a proximal end 106 a and adistal end 106 b substantially along a longitudinal axis 150 a, 150 b.The body 104 of each guide arm 102 a, 102 b further extends between anupper surface 108 a and a lower surface 108 b and is defined by aperimeter wall 110. The perimeter wall 110 can define any suitablyshape, such as, for example, a rectangular perimeter, an oval perimeter,etc. In some embodiments, a guide block 124 is coupled to an outerperimeter wall 112 b of the body 104 of each of the guide arms 102 a,102 b.

In some embodiments, each of the guide arms 102 a, 102 b defines aplurality of guide holes 114 a, 114 b extending from the upper surface108 a to the lower surface 108 b. For example, in the illustratedembodiment, the first guide arm 102 a defines a first plurality of guideholes 114 a arranged parallel to the first longitudinal axis 150 a andthe second guide arm 102 b defines a second plurality of guide holes 114b arranged parallel to the second longitudinal axis 150 b. Althoughspecific embodiments are illustrated, it will be appreciated that thefirst and second plurality of guide holes 114 a, 114 b can extendthrough any suitable portion of respective first and second guide arms102 a, 102 b. The guide holes 114 a, 114 b are each sized and configuredto receive a guide element, such as a k-wire, a screw, etc.,therethrough. The guide element provides a reference point for one ormore additional guides, such as a cutting guide, couple to the guideelement for subsequent surgical procedures.

In some embodiments, each of the guide holes 114 a, 114 b are defined bya guide extension 116 a, 116 b extending from an inner surface 112 a ofthe body 104. The guide extensions 116 a, 116 b define bumps (or peaks)extending from the body 104. In some embodiments, each of the guideextensions 116 a, 116 b defines a sloped guide surface 120 surroundingthe guide hole 114 a, 114 b to guide a cutting element, such as a k-wireor burr, into the guide hole 114 a, 114 b. In some embodiments, theguide extensions 116 a, 116 b are alternated with cutouts 118 a, 118 b(or valleys). The guide extensions 116 a of the first guide arm 102 aare sized and positioned to fit within the cutouts 118 b of the secondguide arm 102 b. Similarly, the guide extensions 116 b of the secondguide arm 102 b are sized and positioned to fit within the cutouts 118 aof the first guide arm 102 b. The guide extensions 116 a, 116 b and thecutouts 118 a, 118 b allow the guide arms 102 a, 102 b to be interlockedin a flush arrangement.

In some embodiments, the first guide arm 102 a includes a thirdplurality of guide holes 122 a and/or the second guide arm 102 bincludes a fourth plurality of guide holes 122 b. The guide holes 122 a,122 b extend from the first surface 108 a to the second surface 108 bthrough a guide block 124 extending from an outer perimeter surface 112b of the body 104. Each of the guide holes 122 a, 122 b is sized andconfigured to receive a fixation element, such as a k-wire,therethrough. The guide holes 122 a, 122 b are configured to guide thefixation element to a predetermined position on the bone. In someembodiments, the guide holes 122 a, 122 b are positioned on an axissubstantially parallel to and offset from the longitudinal axis 150 a,150 b and/or the first/second plurality of holes 114 a, 114 b of therespective guide arm 102 a, 102 b, although it will be appreciated thatthe guide holes 122 a, 122 b may be arranged in any pattern and extendthrough any portion of the guide body 104 and/or the guide block 124.

In some embodiments, the first guide arm 102 a is coupled to the secondguide arm 102 b by a pivot element 130. The pivot element 130 isconfigured to limit respective movement of the first guide arm 102 a andthe second guide arm 102 b to a single plane, such as, for example, afirst plane intersecting (e.g., defined by) each of the longitudinalaxes 150 a, 150 b. In some embodiments, the pivot element 130 isconfigured to allow movement of the first guide arm 102 a with respectto the second guide arm 102 b to adjust an angle Θ₁ defined in the firstplane between the first guide arm 102 a and the second guide arm 102 b.The angle Θ₁ may be adjusted from a minimum angle to a maximum angle.For example, in some embodiments, the first guide arm 102 a and thesecond guide arm 102 b may be adjusted from a minimum angle of 0° (i.e.,the first guide arm 102 a aligned in the same direction as the secondguide arm 102 b) to a maximum angle of 180° (i.e., the first guide arm102 a aligned in an opposite direction as the second guide arm 102 b).Although specific embodiments are discussed herein, it will beappreciated that the pivot element 130 can be configured to continuouslyand/or discretely adjust the angle Θ₁ within any predetermined range,such as, for example, 0-90°, 0-180°, 0-270°, 0-360°, and/or any othersuitable range of angles.

In some embodiments, the pivot element 130 includes a first pivot arm132 a and a second pivot arm 132 b coupled by a pin 134. The first pivotarm 132 a and the second pivot arm 132 b are pivotally coupled such thatan angle (e.g., Θ₁) between the first pivot arm 132 a and the secondpivot arm 132 b can be adjusted. For example, in the illustratedembodiment, the first pivot arm 132 a includes a first coupling portion136 a sized and configured to fit within a second coupling portion 136 bof the second pivot arm 132 b. The second coupling portion 136 b definesa first arm 152 a spaced apart from a second arm 152 b to define acoupling channel 142 therebetween. The coupling channel 142 is sized andconfigured to receive the first coupling portion 136 a therein. When thefirst coupling portion 136 a is positioned between the first and secondarms 152 a, 152 b of the second coupling portion 136 b, pin holes 151defined in each of the first and second coupling portions 136 a, 136 bare aligned. The pin holes 151 are sized and configured to receive a pin134 therein. The pin 134 couples the first coupling portion 136 a to thesecond coupling portion 136 b in a pivoting (or hinged) engagement.Although specific embodiments are discussed herein, it will beappreciated that any suitable coupling mechanism that provides pivotingmovement of the first pivot arm 132 a with respect to the second pivotarm 132 b may be used, and is within the scope of this disclosure. Insome embodiments, the pivot element 130 defines at least one hole (notshown) extending therethrough sized and configured to receive a k-wire,burr, or other element therethrough.

Each of the pivot arms 132 a, 132 b define a guide connection portion138 a, 138 b coupled to and/or formed integrally with the respectivefirst and second coupling elements 136 a, 136 b. The guide connectionportions 138 a, 138 b each define a channel or opening 140 extendingfrom a first surface 139 into the guide connection portion 138 a, 138 b.The channel 140 is sized and configured to receive a portion of arespective guide arm 102 a, 102 b therein. In some embodiments, theguide arm 102 a, 102 b is coupled to the guide connection portion 138 a,138 b by a releasable locking mechanism 143. For example, in theillustrated embodiment, the releasable locking mechanism 143 includes anextension 144 extending from the guide connection portion 138 a, 138 band defining a channel 153 therethrough. The channel 153 extends intoand intersects the channel 140 extending into the guide connectionportion 138 a, 138 b. The interior surface of the channel 153 isthreaded. A locking element 144 is positioned at least partially withinthe channel 153.

As shown in FIG. 4, in some embodiments, the locking element 144includes a threaded shaft 154 extending from an unthreaded head 156. Thelocking element 144 can be tightened and/or locked against the surfaceof the guide arm 102 a, 102 b to maintain the guide arm 102 a, 102 b ina fixed position with respect to the guide connection portion 138 a, 138b. For example, in the illustrated embodiment, the threaded shaft 154 isrotatably interfaced with the internal threads of the channel 153 totighten the locking element 144 against a respective guide arm 102 a,102 b, although it will be appreciated that any suitable lockingmechanism 143, such as a permanent and/or fixed locking mechanism, canbe used to couple the guide arms 102 a, 102 b to respective guideconnection portions 138 a, 138 b. In other embodiments, the pivot arms132 a, 132 b are formed integrally with the guide arms 102 a, 102 b.

In use, and as described in greater detail below, the adjustablesurgical guide 100 a is configured to guide insertion of a one or moreguide elements, such as a k-wire, into the least one bone. A cut can beformed in a bone using one or more guide holes 114 a, 114 b and/oradditional cutting guides coupled to one or more guide elements. Forexample, in some embodiments, a first guide arm 102 a of the adjustablesurgical guide 100 a is positioned adjacent to a bone to position afirst guide element in the bone. The guide element can include anysuitable guide element, such as, for example, a k-wire. The guideelement can be positioned based on pre-operative imaging, simultaneousimaging, and/or using any other method.

After coupling the first guide arm 102 a to the bone, an angle Θ₁between the first guide arm 102 a and the second guide arm 102 b can beadjusted to position the second guide arm 102 b at predeterminedposition on the bone. For example, in some embodiments, the angle Θ₁between the first guide arm 102 a and the second guide arm 102 b can beadjusted to any suitable angle within a predetermined range of angles,such as, for example, between 0-90°, 0-180°, 0-270°, 0-360°, and/or anyother suitable range of angles. A second guide element is insertedthrough at least one hole 122 b extending through the second guide arm102 b.

After coupling the guide elements to the bone, and as described ingreater detail below, the adjustable surgical guide 100 a is removedfrom the surgical site and at least one cutting guide is coupled to oneor more of the first guide element and the second guide element. Acutting instrument, such as a burr, saw, etc., may be positioned throughthe cutting guide and one or more cuts formed in the bone. In someembodiments, the adjustable surgical guide includes one or more openingssized and configured to guide the cutting instrument to a predeterminedposition and/or within a predetermined area of the bone. The cuttinginstrument forms a cut in the bone, for example, to form a wedge cut,osteotomy, and/or other cut in the bone. In some embodiments, the one ormore openings include a slot sized and configured to position a blade orother cutting instrument along a predetermined axis to form a resectioncut in the bone.

FIGS. 5-8 illustrates an embodiment of an adjustable surgical guide 100b including guide arms 202 a, 202 b defining a plurality of scallopguides 216, in accordance with some embodiments. The adjustable surgicalguide 100 b is similar to the adjustable surgical guide 100 a discussedin conjunction with FIGS. 1-4, and similar description is not repeatedherein. Each of the guide arms 202 a, 202 b of the adjustable surgicalguide 100 b includes a plurality of scallop guides 216 sized andconfigured to position a guide element within a hole 114 a, 114 bdefined in the center of each of the scallop guides 216.

In some embodiments, each of the scallop guides 216 includes an innersurface 220 defining a sloped, or scalloped, funnel. A guide hole 114 a,114 b is positioned at the apex (or lowest point) of the sloped innersurface 220. In some embodiments, the inner surface 220 is configured tocontrol motion of a surgical instrument, such as, for example, a burrinserted through a guide hole 114 a, 114 b. In the illustratedembodiment, the scallop guides 216 formed in the first guide arm 202 aare aligned with the scallop guides 216 formed in the second guide arm202 b. It will be appreciated that each of the guide arms 202 a, 202 bcan include a greater or lesser number of scallop guides 216 alignedwith and/or offset from scallop guides 216 in the other of the guidearms 202 a, 202 b.

FIGS. 9-11 illustrate an embodiment of an adjustable surgical guide 100c including first and second guide arms 302 a, 302 b each defining slots310 a, 310 b sized and configured to receive one or more sliding guideelements 312 a-312 d therein, in accordance with some embodiments. Theadjustable surgical guide 100 c is similar to the adjustable surgicalguide 100 a discussed in conjunction with FIGS. 1-4, and similardescription is not repeated herein. In some embodiments, each of theguide arms 302 a, 302 b defines a slot 310 a, 310 b extendingsubstantially along the longitudinal axis 150 a, 150 b of the respectiveguide arm 302 a, 302 b. In the illustrated embodiment, the slot 310 a,310 b extends substantially from a proximal end 106 a of each guide arm302 a, 302 b to a distal end 106 b of each guide arm 302 a, 302 b,although it will be appreciated that the slots 310 a, 310 b can extendover any portion of the respective guide arm 302 a, 302 b and is withinthe scope of this disclosure.

In some embodiments, each slot 310 a, 310 b is sized and configured toreceive one or more sliding guide elements 312 a-312 d therein. Each ofthe sliding guide elements 312 a-312 d include a guide portion 316coupled to a locking portion 320. The guide portion 316 includes anextension 322 (see FIG. 11) sized and configured to extend through aslot 310 a, 310 b of the respective guide arm 302 a, 302 b. The lockingportion 320 is coupled to the extension 322. In some embodiments, thelocking portion 320 is configured to maintain the sliding guide element312 a-312 d in a fixed position within the slot 310 a, 310 b. Forexample, in some embodiments, the guide portion 316 of each of thesliding guide elements 312 a 0-312 d includes a first surface configuredto abut the respective guide arm 302 a, 302 b on a first side. Thelocking portion 320 includes a second surface configured to abut therespective guide arm 302 a, 302 b on a second side. When the lockingportion 320 is tightened to the guide portion 316 (for example, byrotating the locking portion 320 to engage threads formed on theextension 322), the first and second surfaces form a friction lock thatprevents movement of the slideable guide element 312 a-312 d within theslot 310 a, 310 b.

In some embodiments, the guide portion 316 defines a guide hole 314extending therethrough. The guide hole 314 is sized and configured toreceive a guide element, a cutting element, and/or any other suitableelement therethrough. For example, in some embodiments, at least oneguide hole 314 is sized and configured to receive a guide element suchthat the guide element is coupled to a bone at a predetermined location.In some embodiments, a guide element and/or a cutting element may beinserted through a guide hole and the sliding guide element 312 a-312 dmay be subsequently traversed through the slot 310 a, 310 b to select aposition for insertion with respect to the bone along an axis parallelto the axis of the guide arm 302 a, 302 b and/or the slot 310 a, 310 b.

In some embodiments, one or more of the guide arms 302 a, 302 b includesa second guide portion 330 a, 330 b extending along a longitudinal axis350 a, 350 b disposed at a predetermined angle α, β with respect to thelongitudinal axis 150 a, 150 b of the respective guide arm 302 a, 302 b.For example, in the illustrated embodiment, each of the guide arms 302a, 302 b includes a second guide portion 330 a, 330 b extending along athird longitudinal axis 350 a and a fourth longitudinal axis 350 b,respectively, each positioned at an angle of about 90° with respect tothe respective first or second longitudinal axis 150 a, 150 b. Thesecond guide portion 330 defines a second slot 332 a, 332 b sized andconfigured to receive a sliding guide element 312 a-312 d therein. Thesecond slot 332 a, 332 b is configured to guide the sliding guideelement 312 a-312 d along the third or fourth longitudinal axis 350 a,350 b. For example, in some embodiments, the second slot 332 a, 332 bpositions a sliding guide element 312 a-312 d such that a guide elementcan be located within the bone at an angle α, β with respect to a guideelement positioned within the bone by a sliding guide element 312 a-312d positioned within the first slot 310 a, 310 b.

In some embodiments, the first slot 310 a, 310 b and the second slot 332a, 332 b are coupled to form a continuous adjustment slot 334 a, 33 bconfigured to allow continuous movement of a slideable guide element 312a-312 b along a first axis 150 a, 150 b and/or a second axis 350 a, 350b depending on the position of the slideable guide element 312 a-312 dwithin the continuous adjustment slot 334. Although embodiments areillustrated with a single continuous adjustment slot 334 a, 334 bincluding a first slot 310 a, 310 b and a second slot 332 a, 332 b, itwill be appreciated that the guide arms 302 a, 302 b can define anynumber of continuous and/or discrete slots.

FIGS. 12-16 illustrate an adjustable surgical guide 100 d includingmultiple position and angle adjustments, in accordance with someembodiments. The surgical guide 100 d is similar to the surgical guides100 a, 100 b, 100 c discussed in conjunction with FIGS. 1-11, andsimilar description is not repeated herein. The surgical guide 100 dincludes a first extension arm 402 a having a first guide arm 426 aextending therefrom and a second extension arm 402 b having a secondguide arm 426 b extending therefrom. The first extension arm 402 a andthe second extension arm 402 b are coupled by a pivot element 430. Asdiscussed above with respect to the surgical guide 100 a, the pivotelement 430 is configured to adjust a first angle Θ₁ in a first planebetween the first extension arm 402 a (or the first guide arm 426 a) andthe second extension arm (or the second guide arm 426 b). As discussedin greater detail below, in some embodiments, the pivot element 430 isconfigured to adjust a second angle Θ₂ between the first extension arm402 a and a lateral adjustment arm 460 and a third angle Θ₃ between thesecond extension arm 402 b and the lateral adjustment arm 460 in thefirst plane.

Each of the extension arms 402 a, 402 b includes a body 422 extendingsubstantially along a first longitudinal axis 450 a or a secondlongitudinal axis 450 b, respectively. The body 422 extends between anupper surface 422 a and a lower surface 422 b and is defined by a sidewall 424. Each extension arm 402 a, 402 b defines a slot 416 a, 416 bextending from the upper surface 422 a through the body 422 to the lowersurface 422 b. Each slot 416 a, 416 b is sized and configured to receivea threaded connector 440 of a respective guide arm 426 a, 426 b,therethrough. Each of the extension arms 402 a, 402 b include a proximalportion sized and configured to couple to a respective guide connectionportion 438 a, 438 b of the pivot element 430. The extension arms 402 a,402 b can be retained within the guide connection portion 438 a, 438 busing any suitable retention mechanism, such as a friction retention, athreaded retention, the use of tightening element, and/or any othersuitable retention mechanism.

In some embodiments, a guide arm 426 a, 426 b is slideably coupled to arespective one of the extension arms 402 a, 402 b. Each of the guidearms 426 a, 426 b extend from a proximal end 428 a to a distal end 428b. The first guide arm 426 a extends substantially along a thirdlongitudinal axis and the second guide arm 426 b extends substantiallyalong a fourth longitudinal axis 450 d. The guide arms 426 a, 426 b eachinclude a body 425 extending between a first surface 429 a and a secondsurface 429 b and defined by a sidewall 427. A plurality of guide holes454 extend from the first surface 429 a to the second surface 429. Inthe illustrated embodiments, each of the guide holes 454 extends alongan axis that is perpendicular to the longitudinal axis 450 c, 450 d ofthe respective guide arm 426 a, 426 b, although it will be appreciatedthat the guide holes 454 can extend through the guide arms 426 a, 426 bat any suitable angle and are within the scope of this disclosure.Although the guide holes 454 are illustrated extending from a firstsurface 429 a to a second surface 429 b, it will be appreciated that theguide holes 454 can also extend from a third surface 429 c to a fourthsurface 429 b.

In some embodiments, each guide arm 426 a, 426 b is coupled to arespective extension arm 402 a, 402 b by a pivoting slide element 445.The pivoting slide element 445 includes a pivot element 445 comprising afirst pivot connector 448 formed integrally with a proximal end 446 ofthe guide arms 426 a, 426 b and a second pivot connector 444 comprisinga connection extension 440 sized and configured to extend through theslot 416 a, 416 b. The first pivot connector 448 is coupled to thesecond pivot connector 444 by a pivot pin 452 extending through holesformed in each of the pivot connectors 444, 448. In some embodiments,the pivot element 445 allows adjustment of an angle Θ₄, Θ₅ between aguide arm 426 a, 426 b and a respective one of the extension arms 402 a,402 b in a plane defined by the longitudinal axis 450 a, 450 b of therespective extension arm 402 a, 402 b and the longitudinal axis 450 c,450 d of the respective guide arm 426 a, 426 b. In various embodiments,the angles Θ₄, Θ₅ can be any angle within a predetermined range ofangles, such as, for example, any angle within a range of 0°-90°,0°-180°, 45°-90°, and/or any other suitable range of angles.

In some embodiments, each of the pivot elements 445 includes aconnection extension 440 extending through the slot 416 a, 416 b. Theconnection extension 440 is configured to slideably couple the guide arm426 a, 426 b to the respective extension arm 402 a, 402 b. For example,in the illustrated embodiment, the connection extension 440 includes athreaded shaft extending from the second pivot connector 444. Thethreaded shaft is configured to threadably couple to internal threads ofa locking element 442. The locking element 442 is threaded onto thethreaded shaft and maintains the connection extension 440 within theslot 416 a, 416 b. The position of the guide arm 426 a, 426 b along alongitudinal axis 450 a, 450 b defined by the respective extension arm402 a, 402 b can be adjusted by sliding the connection extension 440within the slot 416 a, 416 b. In some embodiments, the locking element442 can be tightened to lock the position of the targeting arm 426 a,426 b within the slot 416.

In some embodiments, each guide arm 426 a, 426 b is configured to rotateabout the respective longitudinal axis 450 c, 450 d of the guide arm 426a, 426 b. For example, in the illustrated embodiment, the second pivotconnector 444 includes a threaded connection extension 440 extendingthrough the slot 416. The locking element 442 can be loosened to allowrotation of the guide arm 426 a, 426 b about the respective longitudinalaxis 450 c, 450 d. After setting an angle of rotation of the guide arm426 a, 426 b, the locking element 442 is tightened to fix the rotationalposition of the guide arm 426 a, 426 b at the selected angle of rotationγ₁, γ₂. The angle of rotation γ₁, γ₂ can include any suitable angle ofrotation, such as, for example, any angle between 0°-360°. In someembodiments, the selected angle of rotation γ₁, γ₂ can be adjusted byrotating each of the guide arms 426 a, 426 b with respect to the pivotelement 445 such that the selected angle of rotation γ₁, γ₂ of the guidearms 426 a, 426 b can be adjusted to position the guide arms 426 a, 426b at any angular position with respect to the pivot element 445.Although embodiments are discussed herein including rotatable guide arms426 a, 426 b, it will be appreciated that the guide arms 426 a, 426 bcan have a fixed rotational orientation with respect to the extensionarms 402 a, 402 b, in some embodiments.

In some embodiments, the adjustable surgical guide 100 d includes alateral adjustment arm 460 including a body 461 extending substantiallyalong a fifth longitudinal axis 450 e from a first end 466 a to a secondend 466 b. The body 461 extends between a first surface 464 a and asecond surface 464 b and is defined by a perimeter wall 468. In someembodiments, one or more guide holes 470 extend through the body 461from the first surface 464 a to the second surface 464 b. The guideholes 470 are sized and configured to receive a guide element and/or anyother suitable element therethrough. The lateral adjustment arm 460 isconfigured to provide lateral movement of the pivot element 430 and theextension arms 402 a, 402 b parallel to the fifth axis 450 e.

For example, in some embodiments, the pivot element 430 is coupled tothe lateral adjustment arm 460 by a lateral adjustment component 476.The lateral adjustment component 476 includes a body 477 configured toslideably contact the first surface 464 a of the longitudinal adjustmentarm 460. A slide element 478 is coupled to the body 477 and isconfigured to maintain the body 477 in contact with the first surface464 a. The slide element 478 can be positioned within a slot 462 definedin the lateral adjustment arm 460 and/or in contact with the secondsurface 464 b of the lateral adjustment arm 460.

In some embodiments, a pivot connector 480 extends from the body 477.The pivot connector 480 defines a pivot pin hole 481 sized andconfigured to receive the pivot pin 434 therethrough. The pivot pin 434couples the pivot element 430 to the lateral adjustment component 476.For example, in the illustrated embodiment, the pivot pin 434 extendthrough the pivot pin hole 481 and is coupled to the locking element435.

In some embodiments, the slide element 478 can be moved laterally withinthe slot 462 to move the pivot element 430 and, by extension, theextension arms 402 a, 402 b. In some embodiments, the slide element 478is coupled to the body 477 by a locking pin 472 having a head 457 incontact with the slide element 478 and a shaft 479 extending through thebody 477 of the lateral adjustment component 476. A locking element 474defines an internal channel 481 having internal threads configured toengage the threads of the locking pin 472 to fix the position of theslide element 478 within the slot 462.

In some embodiments, the pivot pin 434 is configured to allow rotationof the pivot element 430 to adjust a second angle Θ₂ between the firstextension arm 402 a (or first guide arm 426 a) and the horizontaladjustment arm 460 and a third angle Θ₃ between the second extension arm402 b (or second guide arm 426 b) and the horizontal adjustment arm 460.For example, in some embodiments, the locking element 435 can beloosened with respect to the pivot pin 434 such that the pivot element430 is able to rotate about the pivot pin 434 with respect to the pivotconnector 480. Rotational movement of the pivot element 430 adjusts thesecond angle Θ₂ between the first extension arm 402 a and the lateraladjustment arm 460 and the third angle Θ₃ between the second extensionarm 402 b and the lateral adjustment arm 460 while maintaining the firstangle Θ₁ between the first and second extension arms 402 a, 402 b.Although embodiments are illustrated with a rotatable pivot element 430,it will be appreciated that the rotational angle of the pivot element430 may be fixed with respect to the pivot connector 480 and adjustmentsof the angles Θ₁, Θ₂, and Θ₃ may be accomplished solely by movement ofthe extension arms 402 a, 402 b with respect to each other.

FIG. 17 illustrates a method 500 of forming a cut in a bone, inaccordance with some embodiments. At step 502, an adjustable surgicalguide 100 d is positioned adjacent to a bone. Although embodiments arediscussed herein with respect to the adjustable surgical guide 100 a-100d, it will be appreciated that any of the surgical guides 100 a-100 ddiscussed above can be used in conjunction with the method 500 and suchuse is within the scope of this disclosure. In some embodiments, anadjustable surgical guide 100 a includes a first guide arm 102 aextending substantially on a first longitudinal axis 150 a and defininga first plurality of openings 114 a, a second guide arm 102 b extendingsubstantially on a second longitudinal axis 150 b and defining a secondplurality of openings 114 b, and a pivot element 130 coupling the firstguide arm 102 a to the second guide arm 102 b. In some embodiments, atemporary fixation element, such as a k-wire, may be inserted through ahole defined through the pivot element 130, such as a hole extendingthrough a pivot pin 134, to maintain the adjustable surgical guide 100 aat a predetermined position with respect to the bone.

At optional step 504, a first guide element is inserted through aselected one of the first plurality of openings 122 a defined by thefirst guide arm 102 a. For example, in some embodiments, a first guideelement, such as a k-wire, is inserted through a selected one of theholes 122 a defined in the first guide arm 102 a. The first guideelement can be coupled to a bone, for example, prior to and/or afterinsertion of the first guide element through the selected one of theplurality of holes 122 a to define a first reference point for a wedgeosteotomy to be formed in the bone.

At optional step 506, the first guide arm 102 a and the second guide arm102 b are pivoted about the pivot element 130 to adjust the angle Θ₁between the first guide arm 102 a and the second guide arm 102 b withinthe first plane. In some embodiments, pivoting the first guide arm 102 aand the second guide arm 102 b includes increasing and/or decreasing thefirst angle Θ₁ between the first guide arm 102 a and the second guidearm 102 b to define the width of a wedge osteotomy to be formed in abone.

At optional step 508, a longitudinal position of a first guide arm 426a, a second guide arm 426 b, and a pivot element 430 is adjusted along athird longitudinal axis 450 e. For example, in some embodiments, theadjustable surgical guide 100 d includes a lateral adjustment arm 460defining a slot 462. The slot is configured to receive a slide element478 therein. The slide element 478 is coupled to the pivot element 430and is configured to move the pivot element 430 laterally along thethird longitudinal axis 450 e. In some embodiments, the lateraladjustment arm 460 is coupled to the bone by a third guide element priorto and/or subsequent to adjusting the lateral position of the pivotelement 430.

At optional step 510, a longitudinal position of the first guide arm 426a and/or the second guide arm 426 b is adjusted with respect to thepivot element 430. For example, in some embodiments, each of the firstguide arm 426 a and the second guide arm 426 b include a slide element440 disposed through a slot 416 defined by a respective extension arm402 a, 402 b coupled to the pivot element 430. Each of the extensionarms 402 a, 402 b and the corresponding slot 416 extend substantiallyalong a longitudinal axis 450 a, 450 b. In some embodiments, a lockingelement 442 is coupled to the slide element 440 and can be tightened tofix the position of the guide arm 426 a, 426 b within the slot 416and/or can be loosened to allow adjustment of the guide arm 426 a, 426 bwithin the slot 416.

At optional step 512, an angle of the first guide arm 426 a and/or thesecond guide arm 426 b is adjusted with respect to a pivot plane definedby the pivot element 430. For example, in some embodiments, the firstguide arm 426 a comprises an angular pivot element 444 configured toselectively adjust the angle between the longitudinal axis 450 c of thefirst guide arm 426 a or the longitudinal axis 450 d of the second guidearm 426 b and the pivot plane. In some embodiments, the pivot planeincludes a plane defined by the longitudinal axes 450 a, 450 b of theguide arm connectors 432 a, 432 b of the pivot element 430.

At optional step 514, a second guide element is inserted through aselected one of the second plurality of openings 122 b defined by thesecond guide arm 102 b. For example, in some embodiments, a second guideelement, such as a k-wire, is inserted through the selected one of theholes 122 b defined in the second guide arm 102 b. The second guideelement is coupled to a bone to define a second point of reference for awedge osteotomy to be formed in the bone.

At step 516, a cutting guide is inserted through one or more of theguide holes 114 a, 114 b, 214, 454, extending through a portion of theadjustable surgical guide. The cutting instrument, such as a burr, issequentially inserted into the one or more guide holes 114 a, 114 b,214, 454 to form a wedge osteotomy in the bone. In some embodiments, acut may be formed in the bone by pivoting and/or rotating the cuttinginstrument within a guide hole 114 a, 114 b, such as, for example.within a range of motion defined by a scallop guide 216.

FIG. 18 illustrates a method 500 a of forming a cut in a bone using anadjustable surgical guide having at least one slideable guide element,in accordance with some embodiments. Steps 502-506 of the method 500 aare similar to steps 502-206 of the method 500 discussed above inconjunction with FIG. 17, and similar description is not repeatedherein. At step 530, the position of at least one slideable guideelement 312 within a slot 310 defined by one of a first guide arm 302 aor a second guide arm 302 b is adjusted. The slideable guide element 312can include a locking element 320 that is loosened to allow movement ofthe slideable guide element 312 within the slot 310. After repositioningthe slideable guide element 312, the locking portion 320 can beretightened to fix the position of the slideable guide element 312within the slot 310. For example, in some embodiments, the guide portion316 of each of the sliding guide elements 312 a first surface configuredto abut the guide arm 302 a, 302 b on a first side. The locking portion320 includes a second surface configured to abut the guide arm 302 a,302 b on a second side. When the locking portion 320 is tightened to theguide portion 316 (for example, by rotating the locking portion 320 toengage threads formed on the extension 322), the first and secondsurfaces form a friction lock that prevents movement of the slideableguide element 312 within the slot 310. The method 500 a proceeds to step516 and continues through the method steps discussed above with respectto method 500.

Although the invention has been described in terms of exemplaryembodiments, it is not limited thereto. Rather, the appended claimsshould be construed broadly, to include other variants and embodimentsof the invention, which may be made by those skilled in the art withoutdeparting from the scope and range of equivalents of the invention.

What is claimed is:
 1. A surgical guide, comprising: a first guide armextending from a first end to a second end on a first longitudinal axis,the first guide arm defining a first plurality of openings sized andconfigured to receive a first guide element therethrough; a second guidearm extending from a first end to a second end on a second longitudinalaxis, the second guide arm defining a second plurality of openings sizedand configured to receive a second guide element therethrough; a pivotelement coupling the first end of the first guide arm to the first endof the second guide arm such that an angular distance between the firstguide arm and the second guide arm can be adjusted in a first plane; anda first guide block coupled to the first guide arm, the first guideblock extending substantially along a third longitudinal axis that isparallel to the first longitudinal axis, wherein the first guide blockdefines a first subset of the first plurality of openings.
 2. Thesurgical guide of claim 1, comprising: a lateral adjustment armextending from a first end to a second end on a third longitudinal axis,the lateral adjustment arm defining a slot extending substantially alongthe third longitudinal axis; and a slide element coupled to the pivotelement and sized and configured to be received within the slot, whereinthe slide element is configured to provide movement of the pivot elementon the third longitudinal axis and within the first plane; and a lockingelement coupled to the slide element, wherein the locking element isconfigured to selectively fix a position of the slide element within theslot.
 3. The surgical guide of claim 2, wherein the guide elementdefines a plurality of openings sized and configured to receive a thirdguide element therethrough.
 4. The surgical guide of claim 1, comprisinga first extension arm extending on a third longitudinal axis anddefining an adjustment slot extending substantially along the thirdlongitudinal axis.
 5. The surgical guide of claim 4, wherein the firstguide arm comprises a first slide element sized and configured to bereceived within the adjustment slot defined by the first extensionelement, wherein the first slide element is configured to providelongitudinal movement of the first guide arm on the third longitudinalaxis.
 6. The surgical guide of claim 4, wherein the first guide armextends from the first slide element and out of the first plane.
 7. Thesurgical guide of claim 6, wherein the first guide arm comprises anangular pivot element configured to selectively adjust an angle betweenfirst longitudinal axis of the first guide arm and the first plane. 8.The surgical guide of claim 1, wherein the first guide arm defines aplurality of scallop guides sized and configured to guide the firstguide element into a respective one of the plurality of openings.
 9. Thesurgical guide of claim 1, comprising a first locking element configuredto releasably couple the first guide arm to the pivot element.
 10. Thesurgical guide of claim 1, wherein the first guide arm defines a slothaving a first portion extending substantially along the firstlongitudinal axis, the first guide arm comprising a plurality ofslideable guide elements disposed within the slot, wherein the slideableguide elements each define at least one of the first plurality ofopenings.
 11. The surgical guide of claim 10, wherein the first guidearm defines an offset portion extending on a third longitudinal axishaving a predetermined non-zero angle with respect to the firstlongitudinal axis, and wherein the offset portion defines a secondportion of the slot.
 12. A surgical guide, comprising: a first guide armextending from a first end to a second end on a first longitudinal axis,the first guide arm defining a first plurality of openings sized andconfigured to receive a first guide element therethrough; a second guidearm extending from a first end to a second end on a second longitudinalaxis, the second guide arm defining a second plurality of openings sizedand configured to receive a second guide element therethrough; a firstslide element coupled to the first end of the first guide arm; a firstextension element extending from a first end to a second end on a thirdlongitudinal axis and defining a first adjustment slot extendingsubstantially on the third longitudinal axis, wherein the first slideelement is positioned at least partially within the first slot and isslideable on the third longitudinal axis; a second slide element coupledto the first end of the second guide arm; a second extension elementextending from a first end to a second end on a fourth longitudinal axisand defining a second adjustment slot extending substantially on thefourth longitudinal axis, wherein the second slide element is positionedat least partially within the second slot and is slideable on the fourthlongitudinal axis; and a pivot element coupling the first end of thefirst extension element to the first end of the second extension elementsuch that an angular distance between the first guide arm and the secondguide arm can be adjusted in a first plane.
 13. The surgical guide ofclaim 12, comprising: a first angular pivot element coupled between thefirst slide element and the first guide arm; and a second angular pivotelement coupled between the second slide element and the second guidearm, wherein the first angular pivot element is configured to adjust anangle between the first longitudinal axis of the first guide arm and thethird longitudinal axis of the first extension element, and wherein thesecond angular pivot element is configured to adjust an angle betweenthe second longitudinal axis of the second guide arm and the fourthlongitudinal axis of the second extension element.
 14. The surgicalguide of claim 12, comprising: a lateral adjustment arm extending from afirst end to a second end on a fifth longitudinal axis, the lateraladjustment arm defining a slot extending substantially along the fifthlongitudinal axis; and a longitudinal slide element coupled to the pivotelement and sized and configured to be received within the slot, whereinthe longitudinal slide element is configured to provide movement of thepivot element on the fifth longitudinal axis and within the first plane.